Its déjà vu all over again as House Budget Committee Chairman Paul Ryan (R-WI) released a proposed budget blueprint for FY 2013 and proposed legislative language for a budget resolution. With some noted variations, the budget proposal is a repeat of the mean-spirited budget that the full House adopted for FY 2012 on a largely party line vote. Even the name is the same: “Path to Prosperity.” The recycled title is just as misleading today as it was last year. Given what is being proposed, a more complete and correct title would be “Path to Further Prosperity for Those who are Already Very Prosperous.” The subtitle should be changed to “A Blueprint for Misery and Pain for Everyone Else.” And make no mistake; the “everyone else” includes the majority of people living with HIV/AIDS.

Like most documents dealing with the federal budget, Chairman’s Ryan’s proposal for FY 2013 is a mass of numbers and projections. The proposed budget can, however, be boiled down to a few key elements, most dusted off from last year’s proposal:

The budget proposal sets the overall discretionary federal spending level at $1.028 trillion. This is $19 billion below the FY ’13 level called for in the Budget Control Act (BCA) and represents a disturbing break with the bipartisan agreement that was forged last summer to avoid the country defaulting on its debt.

Defense discretionary spending would increase by $8 billion while non-defense discretionary spending would be reduced by over 5%. Non-defense spending includes health care and HIV/AIDS programs and already has been cut by nearly $1 trillion over 10 years under the BCA.

The budget proposal assumes repeal of the Affordable Care Act, including of course Medicaid expansion in 2014 to individuals whose income is at or below 133% of the federal poverty level (FPL). This alone would mean that the large number of people living with HIV who have low incomes and are currently uninsured would continue to have limited or no access to the care and treatment that can save their lives. The impact on people living in the South could be especially dire.

The plan calls for a fundamental and drastic restructuring of Medicaid and Medicare. The entitlement nature of both programs essentially would be eliminated and federal support slashed. Much of the costs would be shifted to the states, in the case of Medicaid, and to the individual, in the case of Medicare. Together, the programs are the top two providers of health care coverage for the overwhelming majority of people living with HIV and AIDS.

Existing tax breaks that benefit the wealthiest individuals and many corporations would be maintained and new tax cuts created. The cost, estimated to be over $3 trillion over 10 years would be paid for by higher taxes for middle class individuals and families and deep cuts in spending for programs that benefit the “99%.”

The proposed budget shreds the intricate web of safety nets not only for low-income individuals and vulnerable populations but for middle class people as well. Funding for food stamps and other programs that provide direct assistance would be reduced significantly. Equally draconian would be the cuts to investing in education, the country’s infrastructure, and to public health.

In many ways, the proposed FY 2013 plan is less a budgetary document and more a political manifesto. Chairman Ryan himself sees the proposed budget as setting a clear difference with President Obama over the role and function of government. It is also a clear difference between a fair and balanced approach, with shared responsibility, to reducing the federal deficit and achieving fiscal stability and a one-sided approach that destroys the social compact, stresses austerity for the many, and awards huge benefits for the very few. The Ryan budget is one more indicator of how important the upcoming November elections are. This election year will provide us with a clear choice. We can choose a path that leads to a true American renewal that can include an end to the AIDS epidemic or we can choose a path that adds to more inequality, more health disparities, and more social and economic injustice. If we can recognize and rise up to meet this challenge, maybe the recycled Ryan budget will have been a service after all.

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